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Organization

NORTHWEST FOOTCARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRYAN D WILHELM DPM (MANAGING PHYSICIAN)
(541) 385-7129
Entity
Organization

Contact information

Practice address
1693 SW CHANDLER AVE, STE 280, BEND, OR 97702
(541) 385-7129
(541) 385-7138
Mailing address
1693 SW CHANDLER AVE, STE 280, BEND, OR 97702
(541) 385-7129
(541) 385-7138

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
213ES0103X
Foot & Ankle Surgery Podiatrist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
213406
OR
01
865318000
BLUE CROSS
OR
01
DD4584
RAILROAD MEDICARE
OR
Enumeration date
08/13/2006
Last updated
02/23/2024
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